Universities in the face of the climate and nature crises: Redoubling our commitment to a sustainable future. The Guild Insight Paper No. 6

Through this paper, written at a time of growing popular disquiet about the role of science and the societal contribution of universities, The Guild urges European policymakers to keep their focus on the Green Deal’s objectives. Precisely at a time when policymakers prioritise Europe’s security and its preparedness for future shocks, it is essential that policymakers recognise the holistic support Europe’s universities can provide to support these endeavours, and align them with the urgent need to address the climate and nature crises. As universities, we also recognise the need to maximise our own contribution to addressing the climate and nature crises in a holistic way. By seeking to further stimulate a wider debate in Europe’s higher education sector, not least through the provision of best-case examples from our members, the Guild urges the university sector to redouble its efforts to strengthen its contributions to addressing the climate and nature crises, supporting the sustainable and just transition of Europe and its constituent nations and regions

Treatment and outcome of aquaporin-4 antibody–positive NMOSD

ObjectiveTo describe the clinical phenotypes, treatment response, and outcome of children with antibodies against aquaporin-4 (AQP4-Ab) neuromyelitis optica spectrum disorder (NMOSD).MethodsRetrospective, multicenter, and multinational study of patients with AQP4-Ab NMOSD aged &lt;18 years at disease onset from a center in Brazil and 13 European centers. Data on demographics, clinical findings, and laboratory results were analyzed; calculation of annualized relapse rates (ARRs) pre- and on-treatment with disease-modifying therapies (DMTs) and of ORs for predictors of poor outcome was performed.ResultsA total of 67 children were identified. At last follow-up (median 4 years, interquartile range 2–10 years), 37/67(57.8%) were found to have permanent disability. A more severe disease course was seen in the non-White ethnicity with both a shorter time to first relapse (p = 0.049) and a worse Expanded Disability Status Scale score at last follow-up (p = 0.008). The median ARR on treatment was 0.18 on azathioprine (n = 39, range 0–4), 0 on mycophenolate mofetil (n = 18, range 0–3), and 0 on rituximab (n = 29, range 0–2). No patient treated with rituximab as first-line therapy relapsed. Optic neuritis at onset was associated with a poor visual outcome below 20/200 (OR 8.669, 95% CI 1.764–42.616, p = 0.008), and a younger age at onset was associated with cognitive impairment (OR 0.786, 95% CI 0.644–0.959, p = 0.018).ConclusionsAQP4-Ab NMOSD in children is an aggressive disease with permanent disabilities observed in over half the cohort. All DMTs were associated with a reduction of ARR. First-line rituximab prevented further clinical relapses. International consensus on treatment protocols for children is required to reduce heterogeneity of treatment regimens used worldwide.Classification of evidenceThis study provides Class IV evidence that for children with AQP4-Ab NMOSD, all DMTs, particularly first-line rituximab, reduced the ARR and prevented further clinical relapses.</jats:sec